Acute Coronary Syndrome Flashcards
What is the difference regarding troop in between NSTEMI, STEMI, and unstable angina?
Troponin will be negative with unstable angina. Troponin will be positive in NSTEMI and STEMI.
Common cardioselective beta blockers
Bisoprolol
Esmolol
Metoprolol
Atenolol
Nebivolol
What is the advantage of cardioselective beta blockers?
They are 20x more potent at blocking beta 1 receptors than beta 2 receptors (and therefore much less likely to cause bronchoconstriction)
List 5 effects of beta blockers as they block sympathetic stimulation of the heart.
1) reduce systolic BP
2) reduce heart rate
3) reduce cardiac output and contractility
4) reduces myocardial o2 demand
5) increase exercise tolerance
EKG Changes in leads II, III and aVF
RCA,inferior LV
Inferior wall IS SUPPLIED BY WHICH CORONARY ARTERY?
The RCA
In Inferior wall MI, which leads will show changes?
II, III and aVF
The LAD supplies which two parts of the heart?
Anterior and septal walls
Changes in V1, V2, V3, and V4 are associated with which coronary artery, and which ventricle?
The LAD or the anterior LV
Changes in V5, V6, I and aVL Are associated with which coronary artery and part of the heart?
The circumflex and the lateral LV
Changes in V1 and V2 Are associated with which coronary artery and part of the heart?
The RCA, posterior LV
Changes in V3R, V4R, Are associated with which coronary artery and part of the heart?
The RCA , right ventricular infarct
Why is troponin/CKMB elevated after reperfusion?
Myocardium is “stunned” by vessel opening.
What type of arrhythmia are seen after coronary reperfusion?
VT, VF, AIVR (from myocardial stunning)
eligibility for PCI during STEMI?
ST elevation in 2 or more contiguous leads New onset LBBB onset of chest pain < 12 hours Chest pain of 30 min Chest pain unresponsive to SL NTG
AV conduction disturbances are seen in which type of MI?
Inferior (RCA occlusion)
Think 3rd degree HB
Why might a systolic murmur develop during inferior wall MI?
Mitral valve regurge secondary to papillary muscle rupture
The RCA supplies which parts of the heart?
The RV and inferior wall of LV
An anterior MI indicates there is a lesion in which coronary artery?
The LAD
New development of second degree type II heart block May indicate which type of MI?
Anterior MI (the LAD supplies the bundle of his)
Heart failure is associated with which type of MI?
Anterior MI
Most incidents of stent thrombosis occur when?
Acutely- within 24 hours of stent placement
Or Subacutely - within the first 30 days
What is the difference between hypertensive emergency/crisis and hypertensive urgency?
Urgency- elevated BP
emergency/crisis - elevatedBP with end organ damage
What is the PRELOAD?
Volume of blood in ventricles at the end of diastole
What is the AFTERLOAD?
Resistance the LV MUST OVERCOME to circulate blood
Nitroprusside reduces the preload or the afterload?
Both
Prolonged qt interval is dangerous for what reason?
It may lead to torsades de pointes.
Which drugs are known to cause prolonged qt?
Haldol, amiodarone, procainamide, methadone, sotolol, quinidine
Pacemaker code
First letter =
Second letter =
Third letter =
Pacemaker code
First letter = chamber paced
Second letter = chamber sensed
Third letter = respond to sensing (inhibitions)
What is the meaning of “failure to pace”?
No spike, or pacing beat, when expected
failure to capture
Spikes occur without a QRS for ventricular pacing.
Failure to sense
Pacer paces during native beats
Anterior wall MI is usually due to LAD occlusion. LAD occlusion usually results in what kind of heart block?
Second degree; type 2 (because LAS supplies the bundle of his)
Which type of MI Is most likely to result in a ventricular septal defect?
Anterior MI (occlusion of the LAD)
Inferior MI is a result of a lesion in which coronary artery?
The RCA
Therefore, patient should be assessed for RV infarct with R sided EKG.
Does morphine lower the preload?
It can ( and worsen hypotension)
